阵发性房颤消融术后空白期快慢综合征治疗与预后
发布时间：2019-02-14 14:46
【摘要】：背景:导管射频消融是治疗心房颤动(以下简称房颤)的有效方法之一,在房颤导管消融术后短期内房性心律失常的发生率可能增加,因此针对这一特殊时期,将其定义为房颤消融后空白期,一些患者在空白期内复发房颤、房速等房性心律失常时,会出现房颤/房速终止后长间歇,称为空白期快慢综合征,但其预后和治疗策略目前尚无相关报道。目的:本文旨在观察阵发性房颤消融术后空白期快慢综合征发生率、临床特点、治疗及预后等。方法:观察2002年1月至2016年6月大连医科大学附属第一医院阵发性房颤消融术后患者,选取空白期出现快慢综合征30例患者(A组)。此外,随机选取同期入院接受房颤导管消融且空白期复发房性快速性心律失常但无长间歇的患者60例作为B组,另随机选取同期入院接受房颤导管消融且无空白期复发的阵发性房颤消融患者60例作为C组。统计这些患者性别、年龄、基础疾病等,对患者进行随访,观察其治疗、预后,比较三组之间消融前后HRV的差异等。结果:(1)2002年1月至2016年6月期间大连医科大学附属第一医院共行房颤导管消融1619例,空白期出现快慢综合征30例(发生率1.9%)。(2)三组患者之间年龄、性别、基础疾病等基线特征均无明显差异(P0.05)。(3)在三组中,患者消融术后HRV各项参数较术前相比均降低,但A组中各HRV指标均无统计学差异(P0.05),在B组中只有SDNN、SDANN有显著性差异(P0.05),C组中,HRV各指标均有统计学意义(P0.05)(4)A组与B组射频消融术后HRV等比较,SDNN、SDANN等少部分有统计学差异(P0.05);A组与C组射频消融术后HRV等比较,有明显统计学差异(P0.05)(5)本次入选空白期快慢综合征患者30例,根据患者意愿,接受导管消融、起搏器植入、观察。平均随访36.9±23.9个月,A组12例患者(40%)进行了再次导管消融(8例为空白期内消融,4例为空白期后消融),其中10例患者无房颤或长间歇,2例患者再次术后仍有房颤发作,但无长间歇;A组3例患者(10%)空白期植入永久性起搏器。15例患者(50%)药物等治疗(随访期内12例患者无房颤等房性心律失常复发,3例患者虽仍有房颤复发,但无RR长间歇)。结论:(1)阵发性房颤导管消融术后空白期快慢综合征发生率为1.9%,可能与神经失衡、迷走神经活跃有关。(2)对于此类患者,大多数预后呈良性,病情呈可逆性。
[Abstract]:Background: radiofrequency catheter ablation is one of the effective methods for the treatment of atrial fibrillation (AF). The incidence of atrial arrhythmias may increase in the short term after atrial fibrillation catheter ablation. It is defined as the blank period after atrial fibrillation ablation. When atrial fibrillation and atrial tachycardia occur in some patients with atrial fibrillation or atrial tachycardia, long intervals after atrial fibrillation / atrial tachycardia terminates, which are called blank period fast and slow syndrome, are found in some patients with atrial fibrillation and atrial tachycardia. However, the prognosis and treatment strategies have not been reported. Objective: to observe the incidence, clinical features, treatment and prognosis of blank fast and slow syndrome after paroxysmal atrial fibrillation ablation. Methods: after paroxysmal atrial fibrillation ablation in the first affiliated Hospital of Dalian Medical University from January 2002 to June 2016, 30 patients with fast and slow syndrome (group A) were selected. In addition, 60 patients with recurrent atrial tachyarrhythmia who were admitted to hospital at the same time and received atrial fibrillation catheter ablation without long interval were randomly selected as group B. In addition, 60 patients with paroxysmal atrial fibrillation (PAF) who were admitted to hospital at the same time and received catheter ablation without recurrence were randomly selected as group C. The sex, age and underlying diseases of these patients were counted. The patients were followed up, the treatment and prognosis were observed, and the differences of HRV before and after ablation were compared among the three groups. Results: (1) from January 2002 to June 2016, 1619 cases of atrial fibrillation catheter ablation were performed in the first affiliated Hospital of Dalian Medical University. 30 cases (1.9%). (_ 2) with rapid onset syndrome occurred in blank period. There was no significant difference in baseline characteristics of basic diseases (P0.05). (3) in the three groups, the parameters of HRV after ablation were all decreased compared with those before operation, but there was no statistical difference in each HRV index in group A (P0.05). Only SDNN,SDANN had significant difference in group B (P0.05), C group, all the indexes of HRV were statistically significant (P0.05) (4) HRV et al. After radiofrequency ablation in group A and group B, SDNN, etc. There were significant differences in SDANN and other parts (P0.05). There was significant difference in HRV between group A and group C after radiofrequency ablation (P0.05) (5) 30 patients with blank fast and slow syndrome were enrolled in this study. According to the wishes of the patients, catheter ablation, pacemaker implantation and observation were performed. After an average follow-up of 36.9 卤23.9 months, 12 patients (40%) in group A underwent re-catheter ablation (8 cases in blank period and 4 cases in post-blank period), 10 of whom had no atrial fibrillation or long interval. Atrial fibrillation occurred again in 2 patients, but there was no long interval. In group A, permanent pacemaker implantation was performed in 3 patients (10%) and drug therapy in 15 patients (50%) (12 patients had no recurrence of atrial fibrillation and 3 patients still had atrial fibrillation recurrence, but no long interval of RR). Conclusion: (1) the incidence of blank fast and slow syndrome after paroxysmal atrial fibrillation catheter ablation is 1.9, which may be related to nerve imbalance and vagal nerve activity. (2) for most of these patients, the prognosis is benign and the disease is reversible.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75
本文编号：2422308
[Abstract]:Background: radiofrequency catheter ablation is one of the effective methods for the treatment of atrial fibrillation (AF). The incidence of atrial arrhythmias may increase in the short term after atrial fibrillation catheter ablation. It is defined as the blank period after atrial fibrillation ablation. When atrial fibrillation and atrial tachycardia occur in some patients with atrial fibrillation or atrial tachycardia, long intervals after atrial fibrillation / atrial tachycardia terminates, which are called blank period fast and slow syndrome, are found in some patients with atrial fibrillation and atrial tachycardia. However, the prognosis and treatment strategies have not been reported. Objective: to observe the incidence, clinical features, treatment and prognosis of blank fast and slow syndrome after paroxysmal atrial fibrillation ablation. Methods: after paroxysmal atrial fibrillation ablation in the first affiliated Hospital of Dalian Medical University from January 2002 to June 2016, 30 patients with fast and slow syndrome (group A) were selected. In addition, 60 patients with recurrent atrial tachyarrhythmia who were admitted to hospital at the same time and received atrial fibrillation catheter ablation without long interval were randomly selected as group B. In addition, 60 patients with paroxysmal atrial fibrillation (PAF) who were admitted to hospital at the same time and received catheter ablation without recurrence were randomly selected as group C. The sex, age and underlying diseases of these patients were counted. The patients were followed up, the treatment and prognosis were observed, and the differences of HRV before and after ablation were compared among the three groups. Results: (1) from January 2002 to June 2016, 1619 cases of atrial fibrillation catheter ablation were performed in the first affiliated Hospital of Dalian Medical University. 30 cases (1.9%). (_ 2) with rapid onset syndrome occurred in blank period. There was no significant difference in baseline characteristics of basic diseases (P0.05). (3) in the three groups, the parameters of HRV after ablation were all decreased compared with those before operation, but there was no statistical difference in each HRV index in group A (P0.05). Only SDNN,SDANN had significant difference in group B (P0.05), C group, all the indexes of HRV were statistically significant (P0.05) (4) HRV et al. After radiofrequency ablation in group A and group B, SDNN, etc. There were significant differences in SDANN and other parts (P0.05). There was significant difference in HRV between group A and group C after radiofrequency ablation (P0.05) (5) 30 patients with blank fast and slow syndrome were enrolled in this study. According to the wishes of the patients, catheter ablation, pacemaker implantation and observation were performed. After an average follow-up of 36.9 卤23.9 months, 12 patients (40%) in group A underwent re-catheter ablation (8 cases in blank period and 4 cases in post-blank period), 10 of whom had no atrial fibrillation or long interval. Atrial fibrillation occurred again in 2 patients, but there was no long interval. In group A, permanent pacemaker implantation was performed in 3 patients (10%) and drug therapy in 15 patients (50%) (12 patients had no recurrence of atrial fibrillation and 3 patients still had atrial fibrillation recurrence, but no long interval of RR). Conclusion: (1) the incidence of blank fast and slow syndrome after paroxysmal atrial fibrillation catheter ablation is 1.9, which may be related to nerve imbalance and vagal nerve activity. (2) for most of these patients, the prognosis is benign and the disease is reversible.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75
【参考文献】
相关期刊论文 前9条
1 赵波;邹操;宋建平;惠杰;;环肺静脉电隔离术治疗阵发性房颤对自主神经功能的影响[J];浙江临床医学;2015年08期
2 黎海文;李天发;王军;张光星;张园园;;慢性心房颤动并长R-R间期射频消融术后窦房结功能测定[J];中国医药科学;2013年18期
3 崔俊玉;;病态窦房结综合征的分型与治疗[J];心电图杂志(电子版);2013年02期
4 常栋;褚振亮;丛培鑫;高连君;张树龙;夏云龙;尹晓盟;董颖雪;张荣峰;杨延宗;;去神经效应对环肺静脉消融治疗阵发性心房颤动远期疗效影响[J];中华心律失常学杂志;2012年02期
5 陶四明;郑甲林;李建美;魏巍;杨志刚;;环肺静脉前庭电隔离对阵发性心房颤动患者消融术后心率的影响[J];中国心血管病研究;2012年02期
6 董建增,马长生,刘兴鹏,龙德勇,刘小青,王京,刘闯,李勇胜,藏敏华,刘晓慧;环肺静脉线性消融电学隔离肺静脉治疗100例心房颤动临床评价[J];中华心血管病杂志;2005年10期
7 周自强,胡大一,陈捷,张仁汉,李奎宝,赵秀丽;中国心房颤动现状的流行病学研究[J];中华内科杂志;2004年07期
8 杨延宗;心房颤动与快慢综合征[J];临床心电学杂志;2003年04期
9 全国心率变异性分析多中心研究协作组,尹彦琳,吴宁,程康安,黄从新,王晋明,蒋文平,刘志华,吕卓人,薛小临,杨钧国,吴俞萍,陆再英,张黎,李莉,王铁锚,黄永麟,曲秀芬,朴晶燕,高冠宇,刘莹;心率变异性正常值及其重复性的多中心研究[J];中华心律失常学杂志;2000年03期
相关硕士学位论文 前1条
1 杨永丽;房性心律失常心率变异性研究[D];山东大学;2012年
，本文编号：2422308
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2422308.html
最近更新
教材专著
